What are adhesions after surgery? How adhesions cause intestinal obstruction


The term "adhesion" is often bandied about by the patient and sometimes by the profession. When used in discussing the abdomen, it refers to the fact that part of its contents become stuck (adherent) together or to its lining wall either directly or by strings or bands of scar tissue. In this regard the inside of the abdomen may have adhesions that look like seven stories of clothesline in the backyard of a tenement, or it may have a broad band of scar like a highway stanchion, or the intestine may be broadly stuck in the way that clothes can be matted to a wad of chewing gum.

Adhesions come from infection or from manipulations within the abdomen. Adhesions are not bad; they represent part of the healing process. They are also one of the body's methods of limiting the spread of inflammation. Virtually everyone who has recovered from an intraabdominal infection can be expected to have some abdominal adhesions. All patients who have been operated on have them. Adhesions become surgically important only when they interfere with function by causing a twist or turn in an organ so that it cannot function normally.

I was operated on and I still don't feel well. I am gassy and belch, and I am always tired and have a sticky discomfort in the incision. Can this be due to adhesions? 
This is a frequently offered explanation; it is in vogue, not necessarily incorrect, and it often comforts the inquirer. This diagnosis should be made very cautiously and only after an intensive X-ray study, blood test and general examination establish it is a fact. The diagnosis of adhesions can be a refuge for uncertainty. It permits an "I told you so" no matter which way events turn.

You imply that I don't have adhesions. No, if you were operated on, of course you have adhesions. But adhesions produce a very specific kind of sickness. The symptoms you have are rarely specially caused by adhesions. Your symptoms are nonspecific in the sense that they can have a large variety of causes.

I have this ugly scar. Does that mean that I have the same kind of ugly healing inside of me? 
In a general way one can say only that the appearance of a skin scar has little to do with what has gone on inside. For what results inside follows from how much infection there had been and how extensive the surgery was. There is, in addition, a personal factor. It would appear that some individuals form more extensive adhesions than others. There is a great individual variability.

How can I have adhesions if I've never been operated on? 
They can come from an appendicitis, an inflammation in the female organs, gallbladder disease, ulcer disease, an abdominal injury or a motorcar accident. For example, a cut heals with a scar; that scar is a type of adhesion.

Can adhesions be seen on the X ray? 
No, not in the sense that we can visualize gallstones,or ulcers, or tumors. However, the X ray may reveal certain changes that we know from experience are caused by adhesions.

What symptoms are produced by adhesions? 
The most important abdominal disease caused by adhesions is a stoppage of the bowels produced by twisting or kinking of the intestine. This is manifested by persistent cramps, constipation, distention of the abdomen and often vomiting.

I've already had two operations for adhesions. What's to prevent this from going on and on? 
Is there a way of dissolving them or preventing them from reappearing? 
There is no way of dissolving them or preventing them. But the physician can often treat the intestinal blockage without operation by means of an intestinal tube inserted through the nose. When recurrent operations for intestinal obstruction are required, it sometimes is possible to sew portions of the bowel together, like frankfurters on a string, to avoid the kind of adhesions that produce symptoms.

I'm anxious to avoid another episode of adhesions where a tube has to be put in and 1 was given intravenous fluids and I had to be in the hospital for ten dayq. Should I have this operated on in between when I am well? 
No, you may never have another such episode. Besides, the preventive operation, such as it is, can be done when you require another procedure for obstruction.

Do adhesions affect other areas besides the intestine? 
Sometimes adhesions from previous infections can close off the Fallopian tubes and cause an inabUity to conceive. If there are many adhesions, secondary surgery of the abdomen may be more difficult than usual.

Can adhesions cause abdominal cramps that come on after I eat or with my menstrual period?
That is possible, but it is hard to be absolutely certain.


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